3 Diabetes Insipidus Nursing Care Plans

Diabetes insipidus (DI) is a disorder in which there is an abnormal increase in urine output, fluid intake and often thirst. It causes symptoms such as urinary frequency, nocturia (frequent awakening at night to urinate) or enuresis (involuntary urination during sleep or “bedwetting”). Urine output is increased because it is not concentrated normally.

Isotonic fluids may be indicated for the patient who has sustained significant fluid loss and is hemodynamically unstable. Once circulatory volume has been restored, hypotonic IV fluids can be given.

Administer medication as prescribed.

Aqueous vasopressin is usually used for DI of short duration (e.g., postoperative neurosurgery or head trauma).

Pitressin tannate (vasopressin) in oil (the longer-acting vasopressin) is used for longer-term DI.

Patients with milder forms of DI may use chlorpropamide (Diabinese), clofibrate (Atromid), or carbamazepine (Tegretol) to stimulate release of ADH from the posterior pituitary and enhance its action on the renal tubules.

Patient verbalizes correct understanding of DI and the medications used in treatment

Nursing Interventions

Rationale

Assess level of knowledge of DI cause and treatment.

An individualized teaching plan is based on the patient’s current knowledge and desire for additional information.

Assess readiness to learn.

Rapid fluid loss from polyuria can lead to impaired cognitive function. This change in mental status can limit the patient’s ability to learn new information.

Give written information concerning the diagnosis and treatment of DI:

Water deprivation ADH stimulation test

This test may be done to differentiate nephrogenic causes from neurogenic causes of DI. The patient is instructed to take nothing by mouth (NPO) for 12 hours before a blood sample is drawn to measure ADH levels. The ADH level is increased in nephrogenic DI and decreased in neurogenic (central) DI. Vasopressin may be given to evaluate renal response. There is no response to the drug in nephrogenic DI.

Computed tomography scan or magnetic resonance imaging

These scans may be ordered if a pituitary tumor is suspected.

Desmopressin acetate (DDAVP)

This is the drug of choice for the management of DI. This medication is a synthetic form of ADH and is administered intranasally.

Aqueous form of ADH (vasopressin)

This drug has a shorter half-life than DDAVP and therefore requires more frequent daily administration. Vasopressin is usually given parenterally and is not recommended for the long-term management of chronic DI.

These secondary drugs work on the kidney or the posterior pituitary gland to increase pituitary release of ADH or increase renal response to ADH.

Teach the patient the necessity of closely monitoring fluid balance, including daily weights (same time of day with same amount of clothing), fluid intake and output, and measurement of urine specific gravity.

This assists the patient in monitoring the condition so that adjustments can be made accordingly, helping prevent undertreatment or overtreatment with the medication.

Discuss when to seek further medical attention (at signs of underdosage or overdosage of medications).

Patients with chronic disease need to be able to recognize important changes in their condition to avert complications and possible hospitalization.

Instruct the patient to wear a medical alert bracelet, listing DI and the medications that the patient is using.